NUR 2502 / NUR2502 FINAL EXAM (LATEST )
MULTIDIMENSIONAL CARE III / MDC 3
Rasmussen University | Comprehensive 150-Question Examination
Course: NUR 2502 Multidimensional Care III | Total Questions: 150 | Format: Multiple Choice (A-D)
Cognitive Levels: 20% Recall · 50% Application · 30% Analysis | Aligned to: NCLEX-RN Test Plan, QSEN
Competencies, NUR 2502 Syllabus
Section 1: Complex Cardiovascular Disorders
Q1: The charge nurse is assigning clients on a telemetry unit. Which client should the nurse
assess FIRST?
A. A client with atrial fibrillation with a ventricular response of 88/min receiving a heparin infusion
B. A client 6 hours post-STEMI with intermittent 2-second periods of sinus arrest on the monitor
[CORRECT]
C. A client with heart failure reporting dyspnea after walking to the bathroom
D. A client 2 hours post-cardiac catheterization with a pulse oximetry of 94% on room air
Correct Answer: B
Rationale:
A client post-STEMI experiencing periods of sinus arrest represents an unstable conduction disturbance that can
progress to complete heart block or asystole and demands immediate assessment and intervention (transcutaneous
pacing, atropine, activation of the rapid response team). The client with atrial fibrillation is rate-controlled and
therapeutically anticoagulated; the heart failure client's dyspnea on exertion warrants follow-up but is not immediately
life-threatening; and the post-catheterization client's SpO2 of 94% on room air is acceptable. NUR 2502 curriculum
emphasizes the ABC and acute coronary syndrome priority frameworks, consistent with the NCLEX-RN Management
of Care Test Plan.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 1
,NUR 2502 Final Exam - Multidimensional Care III 150 Questions
Q2: A client with heart failure reports a 1.4 kg (3 lb) weight gain over 48 hours. Which assessment
finding would the nurse anticipate NEXT?
A. Decreased jugular venous distention
B. Crackles bilaterally in lung bases [CORRECT]
C. Bradycardia
D. Hypotension
Correct Answer: B
Rationale:
A 1.4 kg (3 lb) weight gain in 48 hours signals fluid retention, the earliest and most sensitive indicator of worsening
heart failure. Excess volume backs into the pulmonary vasculature, producing basilar crackles; jugular venous
distention increases rather than decreases. Heart rate typically rises (tachycardia) to compensate for reduced stroke
volume, and blood pressure may eventually fall, but crackles are the most reliable accompanying physical finding.
NUR 2502 reinforces daily weights as a cornerstone of heart failure self-management teaching.
Q3: A client in cardiogenic shock has a blood pressure of 78/46 mm Hg, heart rate 122/min, and
cool, clammy skin. Which provider order should the nurse implement FIRST?
A. Administer a 500 mL normal saline bolus
B. Start a norepinephrine infusion at 0.1 mcg/kg/min [CORRECT]
C. Administer furosemide 40 mg IV push
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale:
Cardiogenic shock is characterized by a failing pump; giving fluids worsens pulmonary edema and myocardial wall
stress, and furosemide would further drop preload in a hypotensive client. Norepinephrine provides both
alpha-mediated vasoconstriction (raising MAP) and beta-1 stimulation (supporting cardiac output), making it the
vasopressor of choice per current shock guidelines. A 12-lead ECG is important but does not stabilize
hemodynamics. NUR 2502 critical care content aligns with the Surviving Sepsis Campaign-style shock principles:
stabilize perfusion first, then diagnose.
Q4: A client with new-onset atrial fibrillation is being started on warfarin. The client asks why a
second medication (heparin) is also necessary. The nurse's BEST response is based on which
rationale?
A. Heparin prevents gastrointestinal bleeding associated with warfarin
B. Warfarin inhibits clotting factors already circulating, while heparin inhibits new clot formation
C. Heparin bridges the gap until warfarin reaches therapeutic INR of 2-3 [CORRECT]
D. Warfarin is contraindicated in atrial fibrillation
Correct Answer: C
Rationale:
Warfarin inhibits vitamin K-dependent synthesis of factors II, VII, IX, and X, requiring 5-7 days to reach a therapeutic
INR (2-3 for atrial fibrillation). Heparin (or low-molecular-weight heparin) provides immediate anticoagulation during
this lag time; this 'bridge therapy' is standard practice until INR is therapeutic. Warfarin is the long-term oral
anticoagulant of choice for stroke prevention in atrial fibrillation. NUR 2502 pharmacology content highlights this
combined therapy as a frequent NCLEX-RN topic.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 2
,NUR 2502 Final Exam - Multidimensional Care III 150 Questions
Q5: A client is 8 hours post-coronary artery bypass graft (CABG) surgery with a mediastinal chest
tube draining 75 mL/hr of serosanguineous fluid. Suddenly the drainage increases to 250 mL in 30
minutes. Which action should the nurse take FIRST?
A. Increase the suction on the chest drainage system
B. Milk the chest tube to remove clots
C. Notify the provider and prepare for potential return to surgery [CORRECT]
D. Clamp the chest tube for 5 minutes
Correct Answer: C
Rationale:
Chest tube drainage exceeding 200 mL/hr (or sudden large-volume output) within the first several hours post-CABG
suggests active hemorrhage and is a surgical emergency requiring immediate provider notification and preparation
for possible re-exploration. Milking or clamping a chest tube is contraindicated because it can increase intrapleural
pressure, dislodge clots needed for hemostasis, or cause tension pneumothorax. Increasing suction is also
contraindicated; chest drainage systems operate at prescribed water seal/suction levels. NUR 2502 post-cardiac
surgery care emphasizes close hemodynamic and drainage monitoring.
Q6: A client with a newly implanted permanent pacemaker asks when they can return to their
normal activities. Which statement by the client indicates the teaching has been EFFECTIVE?
A. "I will avoid lifting my arm above shoulder level on the pacemaker side for 4 weeks." [CORRECT]
B. "I can resume contact sports in 2 weeks as long as I wear a protective pad."
C. "I should avoid microwave ovens because they can reprogram my pacemaker."
D. "I can stop taking my heart failure medications now that I have a pacemaker."
Correct Answer: A
Rationale:
After pacemaker implantation, clients should avoid raising the ipsilateral arm above shoulder level or performing
strenuous activity for 4-6 weeks to prevent lead dislodgement. Contact sports are permanently contraindicated due to
trauma risk. Modern microwaves are shielded and do not interfere with pacemakers; clients can use them safely. A
pacemaker treats dysrhythmias but does not replace medications for heart failure or other cardiac conditions. NUR
2502 patient teaching content focuses on activity restrictions, device identification, and electromagnetic source
avoidance.
Q7: A client who received an implantable cardioverter defibrillator (ICD) 1 month ago reports
receiving three shocks while gardening. Which action is the nurse's PRIORITY?
A. Instruct the client to remain still and have someone call 911 [CORRECT]
B. Tell the client to take their pulse for one full minute
C. Advise the client to drive to the nearest emergency department
D. Recommend the client rest for 30 minutes and recheck symptoms
Correct Answer: A
Rationale:
Multiple ICD shocks in a short period ('electrical storm') suggests recurrent, hemodynamically significant ventricular
dysrhythmias requiring emergency evaluation; the client should remain still, avoid driving, and have someone activate
EMS. Driving is unsafe due to risk of syncope from additional shocks or therapy delivery. Pulse-taking delays
intervention, and 'wait and see' is dangerous with potentially fatal arrhythmias. NUR 2502 cardiac device teaching
emphasizes emergency response for ICD shocks.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 3
, NUR 2502 Final Exam - Multidimensional Care III 150 Questions
Q8: A client with a pulmonary artery catheter has a pulmonary artery wedge pressure (PAWP) of 18
mm Hg (normal 4-12). The nurse interprets this finding as indicating which condition?
A. Hypovolemia
B. Left ventricular failure [CORRECT]
C. Right ventricular failure
D. Pulmonary embolism
Correct Answer: B
Rationale:
PAWP reflects left atrial pressure and left ventricular end-diastolic pressure. An elevated PAWP (>12 mm Hg)
indicates increased hydrostatic pressure in the pulmonary vasculature, classically caused by left ventricular failure
(causing fluid to back up into the lungs). Hypovolemia would produce a low PAWP. Right ventricular failure primarily
elevates central venous pressure (CVP/RAP), not PAWP. Pulmonary embolism typically elevates pulmonary artery
pressure but not wedge pressure. NUR 2502 hemodynamic monitoring content is foundational for critical care
nursing.
Q9: A client is suspected of having a deep vein thrombosis (DVT) in the left leg. Which assessment
finding would the nurse expect to find?
A. Pallor and coolness of the affected extremity
B. Decreased circumference of the affected calf
C. Positive Homans' sign
D. Unilateral calf swelling and tenderness [CORRECT]
Correct Answer: D
Rationale:
Classic DVT findings include unilateral calf or thigh swelling, warmth, erythema, tenderness, and a positive Pratt sign
(pain on dorsiflexion of the foot). Pallor and coolness are signs of arterial occlusion, not venous. The affected leg
would have increased, not decreased, circumference. Homans' sign has low sensitivity/specificity and is no longer
recommended as a diagnostic indicator. NUR 2502 peripheral vascular content emphasizes objective assessment of
leg circumference measurements and prompt D-dimer/ultrasound confirmation.
Q10: A client on a continuous heparin infusion per weight-based protocol has the following
laboratory values: aPTT 110 seconds (control 30), platelets 220,000/mcL, hemoglobin 12 g/dL.
Which provider order should the nurse anticipate?
A. Increase the heparin rate by 2 units/kg/hr
B. Hold the heparin infusion for 1 hour, then restart at a reduced rate [CORRECT]
C. Administer protamine sulfate 50 mg IV push
D. Discontinue heparin and start argatroban
Correct Answer: B
Rationale:
The client's aPTT of 110 seconds is more than 2 times the control value, indicating the heparin is supratherapeutic.
Standard protocol for bleeding-free supratherapeutic aPTT is to hold the infusion for 1 hour and restart at a reduced
rate (typically 25-50% reduction). Protamine sulfate is the antidote for heparin but is reserved for serious bleeding or
markedly supratherapeutic levels. Argatroban is used for heparin-induced thrombocytopenia, which this client does
not have (normal platelet count). NUR 2502 medication management emphasizes aPTT-based heparin titration
protocols.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 4
MULTIDIMENSIONAL CARE III / MDC 3
Rasmussen University | Comprehensive 150-Question Examination
Course: NUR 2502 Multidimensional Care III | Total Questions: 150 | Format: Multiple Choice (A-D)
Cognitive Levels: 20% Recall · 50% Application · 30% Analysis | Aligned to: NCLEX-RN Test Plan, QSEN
Competencies, NUR 2502 Syllabus
Section 1: Complex Cardiovascular Disorders
Q1: The charge nurse is assigning clients on a telemetry unit. Which client should the nurse
assess FIRST?
A. A client with atrial fibrillation with a ventricular response of 88/min receiving a heparin infusion
B. A client 6 hours post-STEMI with intermittent 2-second periods of sinus arrest on the monitor
[CORRECT]
C. A client with heart failure reporting dyspnea after walking to the bathroom
D. A client 2 hours post-cardiac catheterization with a pulse oximetry of 94% on room air
Correct Answer: B
Rationale:
A client post-STEMI experiencing periods of sinus arrest represents an unstable conduction disturbance that can
progress to complete heart block or asystole and demands immediate assessment and intervention (transcutaneous
pacing, atropine, activation of the rapid response team). The client with atrial fibrillation is rate-controlled and
therapeutically anticoagulated; the heart failure client's dyspnea on exertion warrants follow-up but is not immediately
life-threatening; and the post-catheterization client's SpO2 of 94% on room air is acceptable. NUR 2502 curriculum
emphasizes the ABC and acute coronary syndrome priority frameworks, consistent with the NCLEX-RN Management
of Care Test Plan.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 1
,NUR 2502 Final Exam - Multidimensional Care III 150 Questions
Q2: A client with heart failure reports a 1.4 kg (3 lb) weight gain over 48 hours. Which assessment
finding would the nurse anticipate NEXT?
A. Decreased jugular venous distention
B. Crackles bilaterally in lung bases [CORRECT]
C. Bradycardia
D. Hypotension
Correct Answer: B
Rationale:
A 1.4 kg (3 lb) weight gain in 48 hours signals fluid retention, the earliest and most sensitive indicator of worsening
heart failure. Excess volume backs into the pulmonary vasculature, producing basilar crackles; jugular venous
distention increases rather than decreases. Heart rate typically rises (tachycardia) to compensate for reduced stroke
volume, and blood pressure may eventually fall, but crackles are the most reliable accompanying physical finding.
NUR 2502 reinforces daily weights as a cornerstone of heart failure self-management teaching.
Q3: A client in cardiogenic shock has a blood pressure of 78/46 mm Hg, heart rate 122/min, and
cool, clammy skin. Which provider order should the nurse implement FIRST?
A. Administer a 500 mL normal saline bolus
B. Start a norepinephrine infusion at 0.1 mcg/kg/min [CORRECT]
C. Administer furosemide 40 mg IV push
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale:
Cardiogenic shock is characterized by a failing pump; giving fluids worsens pulmonary edema and myocardial wall
stress, and furosemide would further drop preload in a hypotensive client. Norepinephrine provides both
alpha-mediated vasoconstriction (raising MAP) and beta-1 stimulation (supporting cardiac output), making it the
vasopressor of choice per current shock guidelines. A 12-lead ECG is important but does not stabilize
hemodynamics. NUR 2502 critical care content aligns with the Surviving Sepsis Campaign-style shock principles:
stabilize perfusion first, then diagnose.
Q4: A client with new-onset atrial fibrillation is being started on warfarin. The client asks why a
second medication (heparin) is also necessary. The nurse's BEST response is based on which
rationale?
A. Heparin prevents gastrointestinal bleeding associated with warfarin
B. Warfarin inhibits clotting factors already circulating, while heparin inhibits new clot formation
C. Heparin bridges the gap until warfarin reaches therapeutic INR of 2-3 [CORRECT]
D. Warfarin is contraindicated in atrial fibrillation
Correct Answer: C
Rationale:
Warfarin inhibits vitamin K-dependent synthesis of factors II, VII, IX, and X, requiring 5-7 days to reach a therapeutic
INR (2-3 for atrial fibrillation). Heparin (or low-molecular-weight heparin) provides immediate anticoagulation during
this lag time; this 'bridge therapy' is standard practice until INR is therapeutic. Warfarin is the long-term oral
anticoagulant of choice for stroke prevention in atrial fibrillation. NUR 2502 pharmacology content highlights this
combined therapy as a frequent NCLEX-RN topic.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 2
,NUR 2502 Final Exam - Multidimensional Care III 150 Questions
Q5: A client is 8 hours post-coronary artery bypass graft (CABG) surgery with a mediastinal chest
tube draining 75 mL/hr of serosanguineous fluid. Suddenly the drainage increases to 250 mL in 30
minutes. Which action should the nurse take FIRST?
A. Increase the suction on the chest drainage system
B. Milk the chest tube to remove clots
C. Notify the provider and prepare for potential return to surgery [CORRECT]
D. Clamp the chest tube for 5 minutes
Correct Answer: C
Rationale:
Chest tube drainage exceeding 200 mL/hr (or sudden large-volume output) within the first several hours post-CABG
suggests active hemorrhage and is a surgical emergency requiring immediate provider notification and preparation
for possible re-exploration. Milking or clamping a chest tube is contraindicated because it can increase intrapleural
pressure, dislodge clots needed for hemostasis, or cause tension pneumothorax. Increasing suction is also
contraindicated; chest drainage systems operate at prescribed water seal/suction levels. NUR 2502 post-cardiac
surgery care emphasizes close hemodynamic and drainage monitoring.
Q6: A client with a newly implanted permanent pacemaker asks when they can return to their
normal activities. Which statement by the client indicates the teaching has been EFFECTIVE?
A. "I will avoid lifting my arm above shoulder level on the pacemaker side for 4 weeks." [CORRECT]
B. "I can resume contact sports in 2 weeks as long as I wear a protective pad."
C. "I should avoid microwave ovens because they can reprogram my pacemaker."
D. "I can stop taking my heart failure medications now that I have a pacemaker."
Correct Answer: A
Rationale:
After pacemaker implantation, clients should avoid raising the ipsilateral arm above shoulder level or performing
strenuous activity for 4-6 weeks to prevent lead dislodgement. Contact sports are permanently contraindicated due to
trauma risk. Modern microwaves are shielded and do not interfere with pacemakers; clients can use them safely. A
pacemaker treats dysrhythmias but does not replace medications for heart failure or other cardiac conditions. NUR
2502 patient teaching content focuses on activity restrictions, device identification, and electromagnetic source
avoidance.
Q7: A client who received an implantable cardioverter defibrillator (ICD) 1 month ago reports
receiving three shocks while gardening. Which action is the nurse's PRIORITY?
A. Instruct the client to remain still and have someone call 911 [CORRECT]
B. Tell the client to take their pulse for one full minute
C. Advise the client to drive to the nearest emergency department
D. Recommend the client rest for 30 minutes and recheck symptoms
Correct Answer: A
Rationale:
Multiple ICD shocks in a short period ('electrical storm') suggests recurrent, hemodynamically significant ventricular
dysrhythmias requiring emergency evaluation; the client should remain still, avoid driving, and have someone activate
EMS. Driving is unsafe due to risk of syncope from additional shocks or therapy delivery. Pulse-taking delays
intervention, and 'wait and see' is dangerous with potentially fatal arrhythmias. NUR 2502 cardiac device teaching
emphasizes emergency response for ICD shocks.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 3
, NUR 2502 Final Exam - Multidimensional Care III 150 Questions
Q8: A client with a pulmonary artery catheter has a pulmonary artery wedge pressure (PAWP) of 18
mm Hg (normal 4-12). The nurse interprets this finding as indicating which condition?
A. Hypovolemia
B. Left ventricular failure [CORRECT]
C. Right ventricular failure
D. Pulmonary embolism
Correct Answer: B
Rationale:
PAWP reflects left atrial pressure and left ventricular end-diastolic pressure. An elevated PAWP (>12 mm Hg)
indicates increased hydrostatic pressure in the pulmonary vasculature, classically caused by left ventricular failure
(causing fluid to back up into the lungs). Hypovolemia would produce a low PAWP. Right ventricular failure primarily
elevates central venous pressure (CVP/RAP), not PAWP. Pulmonary embolism typically elevates pulmonary artery
pressure but not wedge pressure. NUR 2502 hemodynamic monitoring content is foundational for critical care
nursing.
Q9: A client is suspected of having a deep vein thrombosis (DVT) in the left leg. Which assessment
finding would the nurse expect to find?
A. Pallor and coolness of the affected extremity
B. Decreased circumference of the affected calf
C. Positive Homans' sign
D. Unilateral calf swelling and tenderness [CORRECT]
Correct Answer: D
Rationale:
Classic DVT findings include unilateral calf or thigh swelling, warmth, erythema, tenderness, and a positive Pratt sign
(pain on dorsiflexion of the foot). Pallor and coolness are signs of arterial occlusion, not venous. The affected leg
would have increased, not decreased, circumference. Homans' sign has low sensitivity/specificity and is no longer
recommended as a diagnostic indicator. NUR 2502 peripheral vascular content emphasizes objective assessment of
leg circumference measurements and prompt D-dimer/ultrasound confirmation.
Q10: A client on a continuous heparin infusion per weight-based protocol has the following
laboratory values: aPTT 110 seconds (control 30), platelets 220,000/mcL, hemoglobin 12 g/dL.
Which provider order should the nurse anticipate?
A. Increase the heparin rate by 2 units/kg/hr
B. Hold the heparin infusion for 1 hour, then restart at a reduced rate [CORRECT]
C. Administer protamine sulfate 50 mg IV push
D. Discontinue heparin and start argatroban
Correct Answer: B
Rationale:
The client's aPTT of 110 seconds is more than 2 times the control value, indicating the heparin is supratherapeutic.
Standard protocol for bleeding-free supratherapeutic aPTT is to hold the infusion for 1 hour and restart at a reduced
rate (typically 25-50% reduction). Protamine sulfate is the antidote for heparin but is reserved for serious bleeding or
markedly supratherapeutic levels. Argatroban is used for heparin-induced thrombocytopenia, which this client does
not have (normal platelet count). NUR 2502 medication management emphasizes aPTT-based heparin titration
protocols.
NUR 2502 / MDC 3 Final Exam (2026/2027 Edition) - Rasmussen | Page 4
